Tuesday 23 June 2020

Birth and beyond in a pandemic: Findings from a project with mothers in the England lockdown of spring 2020

Ranjana Das is Reader in Media and Communication, in the Department of Sociology at the University of Surrey. She specialises in the social uses and consequences of technology, with a current, ongoing focus on digital technologies, parenthood and mental health. Her work has been funded by the British Academy, the Wellcome Trust and the Arts and Humanities Research Council.

When I found myself sitting with PPE-clad nurses in a GP surgery with my 8 week old infant being vaccinated amidst pin-drop silence in an empty clinic, I knew that I would raise her, locked down, unable to meet friends, my parents unable to fly in from India to see me, unable to attend post-natal clinics, unable to catch day-time moments of sleep with our 4 year old also home now, as nurseries closed, unable to see anyone for a coffee. Whilst this was very far from the maternity I had imagined, my personal experiences kicked into motion all possible elements of my professional identity. With my academic hat on, I am Reader in Media and Communications, in the Department of Sociology at the University of Surrey, and I have spent the last five years researching the role of digital technologies in perinatal wellbeing, with 3 projects on maternal mental health, migrant mothers’ perinatal mental health and new fathers’ mental health (with Paul Hodkinson) – investigating, in each case, the role of digital technologies at such an intense, critical point in parenthood. I had already published in this area for five years, and now, suddenly, locked down with an infant in my arms, I felt a pressing need to do this fresh spate of new (online) fieldwork, and it gave me an opportunity to do fieldwork in which I was undoubtedly involved and invested myself, in all sorts of ways. The project recruited in a matter of days, and I had to turn many away for the sheer amount of interest I received. In what follows, I summarise some of the findings from this new report available for download freely on this link

COVID19, perinatal wellbeing and the role of technology

The report presents evidence relating to the impacts of COVID-19 on mental health and wellbeing during pregnancy and maternity. The triangle of (1) COVID-19 socio-economic impacts unequally impacting women (2) change in practices antenatally and during childbirth, (3) and social-distancing measures severely restricting women’s social support avenues generates significant additional challenges for perinatal mental health. There is an urgent need to assess this impact on maternal wellbeing (and thus on mothers, babies and families), to set action in motion which prevents significant long-term harm. The report contains findings from a qualitative project with 14 pregnant women and new mothers, conducted during May 2020. The project investigated the disproportionate impacts of the pandemic and resultant social distancing and lockdown measures on perinatal mental health, and the role, efficacy and nuances of formal and informal digital support at such a time. 3 of the 14 participants were in their third trimester of pregnancy, 11 had a very small baby, with babies aged between 4 weeks and 4 months. 4 participants came from South Asian backgrounds and all 14 came across a wide diversity of regions in England. 6 out of the 14 had diagnosed mental health difficulties. There was wide variation in accessing digital support - some were significantly unaware of sources of online support, others using informal connections, some being supported extensively, remotely, by perinatal mental health services.

The report consists of 4 (inter-linked) strands –

1) First, findings on the lines of disproportionate impacts (for instance, exacerbated inequalities or heightened impacts on those with pre-existing mental health conditions);

2) Second, findings on the range of difficult emotions coming up in pregnancy and maternity in relation to the virus and the measures against it;

3) Third, findings about the promises and pitfalls of both formal and informal digital support at such a time; and

4) Finally, recommendations for perinatal support, including digital pathways, for the much-spoken about, but, as yet, uncertain – ‘new normal’.

Disproportionate impacts on new mothers

In this blog, I reflect on the first strand – the disproportionate impacts of the pandemic on maternal mental health in the perinatal period. For 3 out of 4 ethnic minority participants, partners were working outside the home, generating significant anxiety about partners contracting COVID-19 – itself a heightened concern amidst evidence that the disease is disproportionately impacting BAME communities. This was a significant worry for Arfaana whose partner worked long hours in a grocery store. Arfaana’s migration status as dependent on her spouse, a low household income and resultant socio-economic pressures on her partner and herself exacerbated during pandemic, and fuelled cycles of anxiety and depression for her, as she isolated at home, with a new baby. Concerns about her own partner contracting COVID-19 were heightened as well. These concerns were realised for Salma, whose partner contracted COVID-19 whilst working on the NHS. Salma’s exhaustion, with a new baby, diagnosed mental health difficulties and an ill partner, was back-breaking. She said –

“on top of looking after a baby … and doing all the housework, all the cooking, all … you know all of it was … it was just really, really hard, so I was in tears by the end, maybe the last three or four days with it …I think that definitely had a massive impact on my mental health.

Heightened exhaustion as a consequence of gendered inequalities in locked down household workload arrangements featured strongly in the interviews, particularly in cases where an older child was unexpectedly at home, with a new mum on maternity leave with a new baby and/or pregnant. When partners worked outside the home, such inequality was more likely to feelunavoidable, but in many cases, partners continued to work at home but isolated in a room to themselves leading to women picking up a high household load over and above a pregnancy or a new baby. Sophie said –

“at like half eight in the morning he goes up, shuts himself away, he comes down for lunch for like half an hour and then goes back till like six…So even though he’s technically at home, it’s like he’s not here.”

Mother blame and the heavy burdening of women as responsible for infant wellbeing, and solely so, sometimes resulted in heightening of lockdown restrictions – imposed on mothers by either wider family, or even by a partner anxious about the virus. Tanya spoke of feeling as though she lived ‘with a jailer’ and Arfaana spoke of restricting herself to a window for 7 weeks and counting.

Pre-existing mental health and other health difficulties significantly rendered women additionally vulnerable perinatally. Anna found herself suddenly discharged too early from perinatal mental health support which had been going really well for her but left her suddenly unsupported and more vulnerable. Those having to shield were particularly isolated. Sophie, with asthma grasped this isolation succinctly -

“I have some very severe asthma, so I’m classed as extremely vulnerable, so me and my husband, we’re in complete lockdown, so we don’t go out for exercise, we don’t go out for … shopping, I’ve really had to grieve the loss of the idea of the help that I was going to receive.”

Bianca, already under medication for pre-existing anxiety, and shielding owing to chest conditions now worsened owing to virus related anxiety around a premature baby and around herself potentially succumbing to the virus. Likewise, Ellen, with pre-existing health anxiety, struggled significantly with a lack of continuity of care and no partner support at appointments owing to social distancing measures and having to re-explain her difficulties over and again to someone new. These pandemic-related outcomes on professional support worsened perinatal mental health significantly for those already struggling.

Pre-existing struggles with close relationships, for instance, in the case of Tanya, who struggled to find emotional support from her partner, meant her resilience and sense of being able to cope with the pandemic whilst pregnant with a toddler in lockdown, took a significant beating. She spoke of breaking down in tears repeatedly, burdened by an incessant mental load of running her household and doing her job and found the lack of emotional support from her partner significantly difficult. The majority of women spoke of positive interpersonal relationships and supportive family ties, which, in various cases, seemed to ease them through the worst of the perinatal difficulties the pandemic exacerbated for them.

For more findings…

This is just a snapshot of exacerbation of existing difficulties, but the report itself then provides accounts of the nature of difficult emotions experienced, the roles and pitfalls of digital support, and outlines a series of recommendations for the uncertain ‘new normal’. There will be perinatal mental health needs now, in the variable and as yet unknown local, national and global phases of the pandemic, and in a post-pandemic context, and adequacy of support for perinatal mental health needs is a longstanding concern. Thus, for digital support to become truly meaningful in the ‘new normal’, to fill gaps in perinatal support successfully, for the largest numbers of people, and for joined-up, cross-sector, formal and informal collaborations of support, this needs to be in tune with offline, in-person provision and training. Focus on training and leadership on digital support must occur alongside the strengthening of offline support services to face the needs of pregnancy, maternity and perinatal mental health on a longer-term basis. These and other recommendations are unpacked in the full report.

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